SAMPLE

Application Form for Graduate School Admission

Daegu Gyeongbuk Institute of Science & Technology (DGIST)

Academic Year 2012 Admission Type □ Fall □ SpringⅠ □ SpringⅡ □ SpringⅢ Application Number
Desired Degree □ MS □ Ph.D. Desired Major

1. Applicant Information

Nationality

Name
Last/Family Middle First/Given
Date of Birth mm/dd/yyyy □ Female □ Male

E-mail Address

Preferred Telephone □ Home □ Cell Home ( ) Cell ( )

Country/CityCode Country/City Code
Current mailing address
Number & Street City/Town

State/Province Country ZIP Code

2. Education (Universities & Colleges)

List all colleges and universities attended, major field, dates of attendance and name of degrees received or
expected (list most recent first)

University & College Name Location (City/State) Degree Earned Major Dates Attended Grades
mm/yyyy-mm/yyyy
to /

to /

to /

3. (Optional) English Proficiency Test Scores

Scores of your English proficiency test

TOEFL PBT CBT IBT TOEIC IELTS TEPS

 SAMPLE
4. (Optional) References

Names of persons to whom you have given evaluation forms

Name Company/Univ. Position Title E-mail

5. Employment History

Please list your employment, internship, volunteer and other activities in chronological order
(most recent first).

Organization/Institution Location Position/Work description Dates (mm/yyyy-mm/yyyy)

I affirm that all information submitted is true and accurate, and my own work, and that these documents will
become the property of DGIST and not be returned to me.

mm/dd/yyyy

Applicant

To the President of DGIST